P year‎ > ‎Paediatrics‎ > ‎

12.10.03 The final countdown

Intussusception
  • Most commonly around ileocaecal valve
    • Loads of Peyers patches there
  • Red-current jelly stools
    • Pressure => venous obstruction => engorgement => blood loss
  • Pain comes from compression of the serosa of the inside bit
    • Pain fibres are in the serosa
  • DON'T bother doing an AXR
    • Much easier, quicker to see using US
  • Use AIR rather than barium enemas
    • c.f. risk of perforation
  • Frequency 1/300 - 1/350
    • Similar to pyloric stenosis
  • Secondary causes
    • Meckel diverticulum
    • Cancer
      • Commonly B cell lymphoma, in the bowel wall
    • Cysts
    • Polyps


Circumcision

  • Absolute medical indications
    • Phimosis secondary to balanitis xerotica obliterans
    • Recurrent balanoposthitis
  • Relative indications
    • Paraphimosis
    • Balanoposthitis and balanitis
    • Preputial “pearls” and redundant foreskin
    • Phimosis
    • Prevention of sexually transmitted infections?
      • Uncircumcised males are more prone to genital ulcer disease (syphilis, chancroid, herpes simplex) as well as infection with human papillomavirus
      • But circumcised men were more prone to urethritis
    • Prevention of HIV infection
    • Prevention of penile cancer
    • Prevention of urinary tract infection in boys with urological abnormalities
    • Trauma


Notes

  • 6 month old baby, obstruction?
    • Strangulated inguinal hernia (very common)
    • Intussesception
  • Give vitamin K to neonates
    • Otherwise they'll be bleedy up to about 8 days
  • If a bowel loop is wider than the vertebrae, it's distended
  • Triad of obstruction
    • Abdominal distension
    • Bilious vomiting
    • Not pooing
  • COMMONEST CAUSE OF OBSTRUCTION IS A STRANGULATED INGUINAL HERNIA!
  • NEC is a common cause of obstruction in a neonate
  • Posthitis is inflammation of the foreskin

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